Slobbe Laurentius C J, Wong Albert, Verheij Robert A, van Oers Hans A M, Polder Johan J
National Institute for Public Health and the Environment (RIVM), RIVM, PO Box 1, 3720, BA, Bilthoven, The Netherlands.
Tilburg University, Tranzo, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
BMC Health Serv Res. 2017 Sep 5;17(1):626. doi: 10.1186/s12913-017-2570-z.
Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.
The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization.
Top 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41-1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27-1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25-2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52-1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service.
All three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account.
在老龄化社会中，需要更多的长期护理（LTC）设施，因此了解首次使用LTC服务的主要决定因素非常重要。
采用区分前置因素、促成因素和需求因素的安德森服务模型，来建立荷兰普通人群首次使用LTC服务的模型。我们使用了在全科医生数据库（NIVEL初级保健数据库）中登记的214,821人的数据。每个人的病史以及种族、收入、房屋所有权和婚姻状况等特征都是已知的。来自国家长期护理登记处的使用数据在个人层面上进行了关联。使用广义线性模型来确定LTC服务使用事件因素的相对重要性。
LTC的前5个决定因素是需求，以慢性病的存在来衡量，此外还有年龄、家庭规模、家庭收入和房屋所有权。在控制所有其他决定因素后，额外增加一种慢性病会使20岁及以上人群使用任何LTC服务的概率增加45%（OR = 1.45，95% CI：1.41 - 1.49），65岁及以上人群增加31%（OR = 1.31，95% CI：1.27 - 1.36）。对于20岁及以上人群，居住在社会租赁住房中（OR = 2.45，95% CI = 2.25 - 2.67，参照 = 房屋所有者）对使用任何LTC服务有很大影响。独居在较小程度上也有影响（OR = 1.63，95% CI = 1.52 - 1.75，参照 = 非独居）。较高的家庭收入与任何LTC服务的较低使用率相关。
安德森模型的所有三个因素，即前置因素、促成因素和需求决定因素，都会影响未来使用LTC服务的可能性。这意味着在分析决定这种使用的因素时，这些因素都不能被忽视。我们分析中的新之处在于关注事件使用率。与基于患病率的分析相比，这能更好地估计预测因素的影响，因为LTC开始后决定因素的变化造成的混杂因素较少。尤其是护理需求是一个重要因素。因此，健康状况的这种相对重要性对政策的启示是，LTC改革应考虑健康方面。
